A singular solution for healthcare

A single-payer healthcare system would more effectively control costs than any other plan that Congress is considering as it moves toward a reform bill. And by controlling costs, existing resources could be allocated more equitably, especially for the benefit of women.

First, single-payer plans eliminate the $300 billion to $400 billion that insurance companies spend annually in administrative overhead and waste. Second, single-payer plans are best positioned to take on the enormous challenge of reducing or eliminating the financial incentives that have led to so much overtreatment and undertreatment.

Maternity care illustrates this phenomenon: We spend far more per capita than any other industrialized country and yet do worse on most birth outcome measures than most of these other countries. So-called best practices - medical practices already demonstrated to improve outcomes - are well described in the medical literature, but they are not widely implemented, even though doing so would lower costs and improve the health of mothers and babies.

For example, nearly one-third of all US women deliver their babies by caesarean section, a rate that is far higher than medically necessary. One of the reasons is that most obstetricians and hospitals are paid far more for a surgical delivery than for a vaginal birth. Such incentives not only raise costs, but ironically often produce worse health outcomes.

By reducing the ability of for-profit companies to siphon off huge sums of money for private gain, a single payer system is better able to expand best practices. Why? Because the motivations to over-treat those who are well-insured and to undertreat those with limited or no insurance coverage will no longer be built into the medical care system.

Women in particular have much to gain from single-payer healthcare. Our country has an excess of medical specialists, and is in desperate need of more primary caregivers - such as general internists, family practice physicians, nurse practitioners, and licensed midwives - who are often more aptly trained than specialists to provide the comprehensive services women need. A single payer plan would eliminate the financial incentives that have been obstacles to training more primary care professionals. It would also eliminate the need for so many medical malpractice lawsuits, as people would not have to worry about paying for medical care whenever they experienced bad outcomes.

The only national plan for healthcare reform that explicitly includes women's reproductive health services, including abortion, is one sponsored by Representative Barbara Lee, a California Democrat. Other sponsors of single-payer plans are also amenable to including women's reproductive health services.

Coverage with a single-payer plan is independent from employment. Because women are more likely to be self-employed, to work part time, and to move in and out of employment outside the home, they are now more likely either to lack coverage through work or to lose insurance when changing jobs.

Medical debt is an enormous concern for many women, and single-payer plans effectively address the cost issues that send women into debt and even bankruptcy. A 2009 Commonwealth Fund study found that 45 percent of women accrued medical debt or reported problems with medical bills in 2007 compared with 36 percent of men. Under Rep. John Conyers' single-payer bill, a family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs - with no deductibles or copays or concerns about catastrophic costs.

Since a single-payer plan may be the only approach that will successfully contain costs, it was a good sign that Congress finally held hearings on a single-payer system last week.

Although many progressive members of Congress now support a proposal that includes a "public insurance option" as an alternative to private insurance industry plans, numerous critiques demonstrate how this approach could fail. Unless designed to mirror the effective Medicare system - by automatically enrolling the majority of the population and using Medicare's cost control levers - the public option will not be affordable for all.

When polled, a majority of physicians as well as the public support a single-payer plan. For example, a 2007 AP-Yahoo poll asked respondents whether they agreed with this statement: "The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers."

A whopping 65 percent said yes to that question. By political standards, this is a landslide. It is time for Congress to pay attention to the voters, not the well-funded lobbyists.